MDs are not applying for K awards

MDs are not applying for K awards

Over the years I have spoken to hundreds of people about career development (K) awards. One of the best days of my week is Tuesday, when I reserve the full day for phone calls with investigators, mentors, and prospective applicants.

Questions I hear often include:

How many mentors should I have given that…

my research is interdisciplinary?

my research has a translational component?

my interest bridges epigenetics and multimorbities?

These conversations indicate how research has fundamentally changed. Technological advances, sophisticated tools, and the need to be facile with large data sets both define and demand a team science approach. Yet, one critical member of the team—the physician-scientist—is unaccounted for. First you see MD, now you don’t!

Clinician-scientists are critical to research.

We at NIA have always recognized the unique perspective of clinically trained research scientists in the development of treatments for diseases and disorders of aging. Whether it is a physician driven by a frustrating problem in the clinic, or the physician in basic research with a vision of future success in treatment, we need MDs. We need MDs active in research, and we need them to mentor subsequent generations of scientists. Career development (K) award programs play a key role in training clinician-scientists in aging and geriatric research.

But fewer physician-scientists are applying for career development funding.

A review of NIA K applications from 2002 to 2013 shows a steady decline in awards to clinician-scientists, both MD and MD-PhD.

The number of awards to clinicians conducting basic research shows an especially sharp decrease in both our general NIH K program and the NIA-specific Beeson K award program (K08, K23, etc). K08 submissions by MDs have decreased in a big way: from a high of 40% down to 5% of submitted K08 applications over the 12-year period examined.

What’s happening to MD applicants for career development awards and what’s NIA/NIH doing about it?

Although we don’t know yet exactly why this is happening, NIA and NIH take this very seriously. NIA’s Council has formed a task force to look into the extent of the problem and an appropriate response. Kevin High, chair of the group, explains, “…new pathways to support and nurture early faculty are needed to ensure their survival. ‘Pre-K’ models with greater flexibility with regard to percentage of protected research time, leveraged private/philanthropic funding, and allowed salary support for junior faculty should be considered.”

The NIA GEMSSTAR program has been successful in identifying and funding some research-oriented MDs and MD-PhDs. And, our Beeson program is a public-private collaboration that effectively enables larger compensation and lifelong access to a professional peer group for clinician-scientists.

If you have an MD and are active in research, what was your career development experience? If you are currently mentoring a physician-scientist, what are the unspoken challenges you both face? Do you have thoughts about how NIA might best nurture the clinician-scientist pipeline? Join the conversation!

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My general impression is that there is an income problem. First, clinicians are under pressure to bring in income through procedures and visits, and every dollar not earned is a loss to the clinic. Second, whatever the arrangements of the K award, ultimately the salary support cannot compete with the clinical earning potential. So the clinic is not only losing money on the procedure not billed, but it also has to make up the salary shortfall to the investigator. Note that it doesn't help to remove the NIH salary cap, which would just mean that a grant would still be eaten up by salary for comparatively low effort.
I do believe there are MDs who would be interested in transitioning to research. But with medical school loans to pay off, there is an expected salary rate. Becoming a researcher either means giving up the salary and living on the comparatively monk-like salary of a mere PhD, or it means asking peer clinicians to support you while you toil away in the lab, losing them money.

Posted by Tatiana on Jun 12, 2014 - 10:17 am

I am one of clinicians who is in process to apply for a professional development grant, not K yet. I am a surgeon. I am glad to see this topic discussed, as there are many challenges to overcome. Salary and finances are important but it would be too simple to state that this is it. In fact, I do not think that it is the most important factor. Health care changes would affect who we conduct clinical research. Reserach is frequently not a strong factor in residency training in many programs. Young physicians are not prepared to face the reality of clinical practice and to aspire to their scientific goals to advance a respective field. It takes a creative mind, a torch inside your heart, and very supportive environment to overcome daily chores to continue your research.

Posted by MDPhD on Jun 21, 2014 - 11:35 am

After 2 failed attempts at K-awards following 8 years of MD-PhD work, publications in 2 highly-respected journals for my PhD Dissertation, significant recognition by mentors, and a 7% funding rate from NIH, I gave up on my life's passion of research. I redirected my career to private practice, where I could tackle interesting problems on a daily basis, support my family, and live a fulfilling life. I still have a minor component of research in my practice, and I would be interested in growing it, but I don't have the ability or desire to commit the amount of time and energy required to survive in a system that often doesn't reward excellent work. I still have ideas and projects in my mind for basic, translational, and clinical research, but so far I have been able to secure only minimal outside funding for such projects through a non-profit, where funding is also scarce. Also, my clinical demands don't provide me with anywhere near the percentage of dedicated time required for a K award. Not only do I have to pay my salary, but I also have to cover my portion of overhead for the practice. I don't see an easy solution to these problems, but I don't think the model is working at this point. If there were some sort of hybrid model, maybe where you could spend 20-30% of your time doing research, with adequate reimbursement, it might work.

Posted by MD on Jun 23, 2014 - 5:16 pm

Sorry to hear of your failure to secure funding, and the government's failure to support what sounds like some good work on your part.

Posted by Chyren Hunter on Jun 24, 2014 - 10:30 am

Thanks so much for these helpful comments. You've all made some excellent points about salary structure and medical school loans, as well as the priority placed on research in residency programs and limited NIH funding meaning low success rates for grant applications. For clinicians new to aging research, NIA has had success with a hybrid model, the NIA GEMSSTAR, a small grant research project providing K-level mentorship (see http://www.nia.nih.gov/research/blog/2013/08/funding-opportunity-medical-and-surgical-specialists-establish-track-record). Solutions won't be easy, but we're working hard to find and consider options. I've added links to the Working Group report in the post above. Stay tuned for more in the coming months.

Posted by Mud-Phud on Aug 01, 2014 - 4:51 pm

I perused with interest the recent working group report that you referenced on this important topic, and I think there is one important factor contributing to the decline in young physician-scientists that has not been brought up yet. As a physician-scientist that has mentored both pre-doctoral (MSTP) and post-doctoral (housestaff) physician-scientists, it is clear that the transition from trainee to independent investigator is indeed a key period. However, the career satisfaction of mid-career physician-scientists also plays a critical role in supporting the young physician-scientists, as it is that group that recruits, mentors and acts as "cheerleaders" to help the junior faculty be persistent in pursuing their research goals. Most young scientist look up to their mid-career predecessors not only for mentorship and advice, but also as role models that allow them to envision their future balance of career and private lives.
Thus, efforts to promote the retention of physician-scientists in the research workforce should not be limited to the early career development award stage, but also to better support established physician-scientists through the current NIH climate. A gap in funding due to difficulties with competitive renewal is usually accompanied by pressure to take on greater clinical responsibilities and reduce the size of one's lab, which creates a feed-forward cycle that makes it even harder for the physician-scientist to maintain his or her research programs. Several of my colleagues are facing closing down their labs due to this. This represents not only a significant loss from a group of physician scientists with proven ability to run research programs, but also has a further discouraging effect on the emerging physician scientists that look to the mid-career established physician-scientists as role models and mentors. Several Assistant Professors I have spoken to point out that they have no chance if even established researchers are having trouble keeping their labs open. A comprehensive strategy to keep the physician-scientist pipeline open should include provisions targeting both early and mid-career physician-scientists. Thank you.

Posted by K23 on Aug 27, 2014 - 1:25 pm

I am a current K23 recipient and I feel lucky that I am able to stay on my preferred career path. However, I second/third the increasing pressure from the clinical administration as a major impediment in physicians trained in the basic sciences sticking with a research career. NIH funding aside, all academic medical centers are looking under the cushions for change, especially given lower reimbursements for procedure and non-procedure based specialties, restricted resident work hours, rising costs of mid-level providers and nurses, and all the hospital/system mergers taking place across the country. Asking research faculty to use their protected time for clinical or administrative purposes is the easiest temporary solution, but the temporary solution at my institution has been in place for 3 years with no end in sight. IOM recently recommended changes in residency training funding mechanisms to the hospitals' dismay. Are there similar solutions to reinvigorate the clinician investigator/physician scientist career path?

Posted by Chyren Hunter on Sep 08, 2014 - 1:18 pm

We hear you! Keeping clinician scientists in the pipeline means investing in strategies at every point: entry level, during that first transition to independence, and at mid-career to support the investigator who is mentoring the next generation. The difficulty in maintaining a clinical practice and a 75% research commitment remains a tough issue. NIA has the GEMSSTAR R03 program, as discussed in previous blogs. With our National Advisory Council K Task Force we also hope to make an impact on this issue. Thanks for sharing and stay tuned!